A randomized clinical trial to compare levonorgestrel-releasing intrauterine system (Mirena) vs trans-cervical endometrial resection for treatment of menorrhagia

Shirin Ghazizadeh1, Fatemeh Bakhtiari1, Haleh Rahmanpour2, Fatemeh Davari-Tanha1, Fatemeh Ramezanzadeh11Valie-Asr Reproductive Health Research Center, Valie-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Obstetrics and Gynecology, Ayatollah Mousavi Hospital, Zanjan, IranObjective: To compare the acceptability, efficacy, adverse effects, and user satisfaction of the levonorgestrel intrauterine system (LNG-IUS) and trans-cervical resection of the endometrium (TCRE) for the treatment of menorrhagia.Method: 104 women with menorrhagia were divided into 2 groups: 52 women had the LNG-IUS inserted and 52 underwent TCRE. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, and rates of acceptability and satisfaction, were recorded at 6 and 12 months after the procedure.Results: After a year there were reductions of 93.9% and 88.4% in menstrual blood loss in the TCRE and LNG-IUS groups, respectively. Amenorrhea was more common in the TCRE group and spotting and systemic effects in the LNG-IUS group. Satisfaction rates of the TCRE group were higher than the LNG-IUS group (80.8% vs 69.2%), but the difference was not statistically significant.Conclusion: Although both treatments were found to be equally effective, LNG-IUS was less invasive and can be advised for younger women with a desire to preserve fertility.Keywords: menorrhagia, trans-cervical endometrial resection, levonorgestrel-releasing intrauterine syste

British or American? Iranian EFL learners’ Perceptions toward English Accents: Exploring possible relationships

Native English accents (British and American) are known as highly favored and accepted varieties compared to other existing accents in English as foreign language (EFL) context. Notwithstanding the research accomplished on EFL learners’ attitudes toward either of the accents (British or American), studies are still scant regarding the investigation of their perspectives in detail toward one of the accents specifically within the context of Iran. The aim of this study is to examine the Iranian EFL learners’ attitudes toward the two major known English accents (British and American. Additionally, the study highlights the major factors contributing to the learners’ preferences toward either of the accents (British or American). To that aim, a developed and validated questionnaire was distributed among 108 EFL learners selected from two of the major EFL contexts (universities and private institutes). The results indicated that the majority of the learners preferred American over British English accent. Besides, factor analysis revealed that American English exposure, lack of guidance, and lack of reinforcement toward British accent were among the mentioned factors accepted by learners for their preference of American. Finally, the study concludes with interpretations regarding the learners’ decision making issues in either of the two major accents, and recommendations are provided for revisiting the EFL learners’ attitudes and insights toward native English accents

Female sexual outcomes in primiparous women after vaginal delivery and cesarean section

Background: Sexual function is an essential component of life and yet very little is known about the relationships between the female sexuality and the mode of delivery.Objective: To compare sexual outcomes after vaginal delivery and cesarean section.Methods: A cross-sectional study was conducted on women in two stages; early pregnancy and 3 to 6 months after delivery in health centers. Female sexual outcomes evaluated were female Sexual Function Index scores and the time required to resume sexual activities after delivery.Results: Sexual function did not differ significantly among two groups vaginal delivery n=90 and cesarean section n = 113 with regard to duration of marriage, educational level, contraception methods, and occupational status p = 0.8.The mean timing of the resumption of sexual activity was 8.9 ± 1.3, and there was no substantial conflict between the two groups. Mean frequency of intercourse in the post-partum period was 1.8±1.2 times per week with significant difference compared to pre pregnancy P<0.05. The individual domain scores after the delivery was significantly lower in comparison with pre-pregnancy p<0.004.Conclusion: No differences in sexual outcomes between vaginal delivery and cesarean section. Consequently cesarean section cannot be recommended in the view of maintenance of normal sexuality after child birth.Keywords: Women’s health, cesarean section, post-partum, vaginal delivery, female sexual functio